Patient Forms

 

 

 The following Patient Forms can be printed from your computer and filled out at your leisure before your first appointment. Printing them, filling them out and bringing them with you will allow us to attend to your dental needs more quickly than completing them on your arrival.

Please bring in a Medical History, HIPPA (Patient Acknowledgement of Privacy Practices) Form and Financial Policy for each patient. If you have records at another dentist, please fill out and send the patient record request to them so that we will have that information at your first appointment.

If you have any questions, please do not hesitate to give us a call:

860.233.0552

 Medical History.pdf

 Kids Health History.pdf

 Notice of Privacy Practices HIPPA.pdf

 General Consent and Statement of Responsibility.pdf

 FINANCIAL.pdf 

 

Please see our Common Questions for frequent new patient questions.

You will need Adobe Acrobat Reader to access the forms.

 


ACCESSIBILITY